- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,378.71 / $2,378.71 / $2,378.71
| Facility | | $2,378.71 | $2,378.71 | $2,378.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,199.18 / $10,945.66 / $21,140.13
| Facility | | $5,199.18 | $10,945.66 | $21,140.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,599.70 / $8,739.68 / $21,024.48
| Facility | | $5,599.70 | $8,739.68 | $21,024.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,852.63 / $7,975.53 / $16,554.71
| Facility | | $4,852.63 | $7,975.53 | $16,554.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,378.71 / $4,020.02 / $7,430.38
| Facility | | $2,378.71 | $4,020.02 | $7,430.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.00 / $3,500.00 / $8,152.00
| Facility | | $796.00 | $3,500.00 | $8,152.00 |